The Anthrax Letters: The Attacks That Shocked America (32 page)

A June 1999 document prepared by the Association for Professionals in Infection Control and Epidemiology (APIC) in cooperation with the CDC was more definitive: “Decontamination should only be considered in instances of gross contamination” In bold print the document also stated: “Potentially harmful practices, such as bathing patients with bleach solutions, are unnecessary and should be avoided.” The APIC statement apparently was the first to explicitly warn against washing people with bleach because it could cause them harm. Moreover, it was followed in August with an observation by CDC officials that “the actual efficacy of disinfection with sodium hypochlorite [bleach] in cases of bioterrorism is questionable.”

Scrubbing victims with bleach solutions was not the only “questionable” practice of emergency responders to bioterrorism threats. Many incidents involved other erratic actions as well. Inconsistencies may be seen in
Table 1
, which lists information on 40 anthrax hoaxes. Representing about 20 percent of the total of some 200 incidents that occurred between April 1997 and June 1999, they were selected because of either of two criteria: first, available information indicated large numbers of people were affected or, second, aggressive treatments were rendered. The data were drawn from news articles, official reports, and personal interviews with officials and victims.

Actual numbers of evacuated or quarantined victims were available for only 30 of the 40 listed incidents. These totaled 12,398. The numbers reported for the other 10 listed incidents were variously described as “several” or “hundreds.” Thus, for the 40 incidents, the number of lives disrupted approached 13,000. For the approximately 200 incidents, the figure surely exceeded 13,000.

Among the 40 listed hoaxes, in 26 of them, the victims underwent decontamination (usually with bleach solution), and in 20 they received antibiotic treatment and/or were hospitalized. In 30 of the incidents (75 percent of the total), potential victims were subjected to at least one of these aggressive responses.

Table 1
reveals the breadth of inconsistency but nothing about the psychological effects on the victims. Interviews indicated that several people in the targeted areas were unfazed and considered the episodes minor inconveniences. But many were terrified. Similarly, some felt that emergency response teams acted efficiently and sensitively. Others, even months after the experience, were bitter about having undergone embarrassing and intrusive treatment.

Thus, 2 years after the B’nai B’rith event, local response teams were still repeating the errors of that experience. Responsibility largely lay with the delayed introduction of clear and rational protocols by the CDC and other national agencies. Descriptions of several incidents demonstrated the variety of responses and their effects on the victims.

The NBC network news office in Atlanta, Georgia, is on the 11th floor of a 12-story office building. Around noon on Thursday, February 4, 1999, an employee opened a mailed envelope containing a baggie full of material that looked like dark sand and pepper. An accompanying letter said: “You and everyone in this building have been exposed to anthrax.” People in the office called 911, the FBI, and the CDC. Two plainclothes police officers quickly came over from the police headquarters across the street. Later, more emergency responders arrived, including additional police and paramedics.

All seven NBC employees and the two plainclothes officers were sprayed with a bleach solution while in the office and fully dressed. Then, in wet clothing the nine victims were taken to the elevator and down to the lobby. The lobby was filling with people from other floors who had learned of the anthrax threat and were trying to leave the building. As the nine victims got off the elevator, other police officers ordered them to return upstairs. Meanwhile, officials were sealing off a four-block area. Some of the 600 people in the area had been evacuated but most remained under quarantine.

Fire department personnel arrived 45 minutes after the first telephone calls. Some were dressed in “space suits” and went up to the 11th floor, where they sprayed the hallways and the NBC office with a bleach solution. The nine victims also received a second spraying, again while fully clothed.

An NBC staff member recounted her experience to me. Felice (a pseudonym) was among the nine who were sprayed. Her clothing, like that of the others, had turned pale from the bleach. After the second spraying, the nine were again taken to the lobby by elevator. This time they were escorted out of the building to awaiting ambulances. Still clothed and drenched, Felice and another woman got into one of the ambulances but were immediately ordered out because “someone said we might be contaminating the ambulance.”

The two women were escorted to a nearby HAZMAT truck where, along with the other victims, they were decontaminated again. One at a time the nine victims undressed and submitted to a third bleach washdown. Following a shower in the truck with plain water, they were given sheets to wrap themselves in. As they exited the truck, a man held a tarp to block the view of onlookers. There were not enough ambulances for everyone, so the five women were taken first and the four men were left to wait until other ambulances arrived. Once in the ambulance, Felice was told she would have to be hooked to an intravenous (IV) line. She objected strenuously. “I hate needles,” she said, but was told she had no choice.

Upon arriving at Grady Hospital, the victims found that outdoor showers had been set up on a platform in front of the entrance. Felice and the other women were told they could not enter the hospital until taking a shower (their fourth decontamination). “The area was not closed off, and we had to take off our sheets and go under the shower in public view,” she told me. While still attached to the IV line, Felice washed herself with the detergent soap she was given. “For some of us, the water was so hot it felt scalding. But others had very cold water. It really was erratic.”

TABLE 1
Forty Selected Anthrax Hoaxes, April 1997-June 1999 (based on whether victims were reported to have received treatment or if large numbers were affected)

 

Inside the hospital the five women were given hospital greens to wear. Soon after, they were told that initial tests showed no evidence of anthrax. The test results became available before the male victims were brought to the hospital so they were spared the shower in public view.

Felice said she felt less troubled by the experience than some of her co-workers. “They were angry they had to go through this,” she said. “The thing that mainly got to me personally was having to have the IV. For what purpose?” In the days afterward, Felice thought about the event and how poorly it was handled. She wondered why the men holding the tarps up were not in “moon suits” when all the other personnel were. “That made no sense to me.” Also, she said that it had been difficult to understand what people were saying while in their masks. Much of the time the victims tried to interpret hand motions by the personnel in masks because their verbal commands were unintelligible. Moreover, Felice felt frustrated by a lack of singular direction. “There were a lot of different agencies, but it was not clear who was in charge.”

The day after the incident the victims were visited briefly by a group of health officials from the CDC. The officials told them that the chances that anyone was exposed to anthrax were very remote but that they would not know for sure until laboratory tests were completed in the next few days. Later, when learning more about anthrax, Felice wondered, “In that case, shouldn’t we have been taking antibiotics?”

Felice thought that the CDC and other agencies might have gained knowledge by inviting the victims to discuss their experiences at length. Hearing from the victims could help responders understand the psychological dimension and improve their actions in the future. Four months after the event, when I spoke to her, Felice was still lamenting the lack of such follow-up. Although the incident was no longer a central concern at the NBC office, “we all watch the mail a little more cautiously now,” she said.

Meanwhile, according to Lieutenant Reggie Latimer, who led the fire department’s response at the Atlanta NBC site, the experience taught everyone a lot. In the future he said, “we would not be so quick to have people decontaminated under those circumstances.”